inflammatory bowel disease Flashcards
what is IBD?
two chronic inflammatory GI disorders
- chrons and ulcerative colitis
- complex disease that arises because of environmental and genetic factors
- approx 260000 canadians have IBD
cause of IBD?
mainly known possible causes: -autoimmune factors -genetic factors -environmental triggers (pesticides, food additives, tobacco- chrons, radiation, NORTHERN alberta??) -bacteria d/t antibiotic use
chrons disease?
subacute/chronic inflammation anywhere in GI tract, most commonly impacts distal ileum and colon
- discontinuous “skip lesions”, clusters of ulcers
- transmural: therefore complications can include absecesses, fissures, fistulas, perforation
in advanced disease, bowel can thicken, become fibrotic, narrowed and disease loops can adhere to other loops… risk for
bowel obstructions (dont use metoclopramide!)
crohns assessment?
- RLQ pain (ileum/ascending colon) that occurs with diarrhea but does not decrease with defecation
- palpable RLQ tenderness and hyperactive bowel sounds
- weight, nutritional status
- steatorrhea
- extraintestinal manifestations
crohns complications?
SBO
- fluid and electrolyte imbalance
- malnutrition
- fistula and abscess formation
- increased risk for colon cancer
- retinitis, iritis, erythema nodosum
- mood disorders
what is ulcerative colitis?
inflammation of mucosal and submucosal layers of rectum, advancing proximally through colon
-continuous ulceraton
-can lead to pseudopolyps—> why may cause pain and bleeding
at increased risk for toxic megacolon, perforation, colon cancer, nephrolithiasis
ulcerative colitis assessment?
LLQ pain, abd distention, assess weight and nutritional status, dehydration, electrolytes, blood in stool
complications of ulcerative colitis?
toxic megacolon perforation bleeding from ulceration fluid/electrolyte imbalances malnutrition depression nephrolithiasis malignant neoplasms
common presentation?
chronic diarrhea, abd pain, fever, arthritis, anorexia
IBD diagnostics?
- proctosigmoidoscopy or colonoscopy with biopsy= GOLD standard
- barium enema
- upper GI series
- CT scan
- CBC, alb, K+, Na+, RFTs
- stool culture (blood/occult blood, steatorrhea- opaque or white, fat., parasites)
IBD management?
reduce inflammation (prednisone)
- suppress inappropriate immune response (infliximab, sulfasalazine)
- rest bowel (parenteral nutrition)
- correct fluid and electrolyte imbalance
- nutritional therapy
- prevent or minimize complications
surgical interventions?
- total colectomy (ileostomy)
- continent ileostomy (k-pouch)
- temporary loop ileostomy
- ileoanal anastomosis with J-pouch
pharmacology for IBD?
- corticosteroids (prenisone, hydrocortisone)
- amino salicylate formulation (sulfasalazine)
- monoclonal antibodies (infliximab= remicade)
- opioids
- antiperistaltics and antidiarrheals MAY be used to rest bowel during extreme flares, supportive care NOT curative
corticosteroids?
regulate vital functions involving CV, metabolic, and immunologic functions
- effects are diverse as well as their potential side effects
- quickly and effectively suppress inflammatory and immune response
- EXAMPLE: hydrocortisone and prednisone
common uses for steroids?
- adrenocortical insufficency
- asthma
- COPD
- IBD!!
- spinal injury
- allergic reactions
- post-transplant rejection
- arthritis
- cancer
- nausea related to chemo
common side effects of corticosteroids (lots!!)
- increased blood glucose
- decreased immune response (increased risk of infection)
- decreased inflammatory response
- decreased wound healing
- weight gain/facial swelling (moon face)
- osteoporosis
- increased risk of ulcers
- increased risk of mood disorders
- electrolyte disorders
- steroid induced psychosis?? euphoria??
- recommend to have PPI on board
- CONTRAINDICATED IN PREGNANCY
- can become addicted long-term -dehydration (fluid volume deficit)
how to minimize side effects of corticosteroids?
- short periods of time
- large doses initially then gradually decrease
- increased risk of side effects after continually use for 7-10 days
- give steroids with food
- alternate day dosing
- locally instead of systemically given
nursing considerations for corticosteroids?
-monitor for potential hyperglycemia
-give oral steroids with food if possible
-monitor for s and s of infection, skin breakdown
monitor electrolytes (increased Na, decreased K)
monitor mood/behaviour changes
5-ainosalicylic acid???
chemically similar to aspirin 5-ASA is a metabolite of sulfasalazine -helps to decrease symptoms of IBD (fever, stomach pain, diarrhea, rectal bleeding) ANTI INFLAMMATORY -SULFASALAZINE
monoclonal antibodies?
form of immunotherapy
-mAb bind to specific target cells or proteins and possible stimulate pt immune response to attack those cells
-also used in cancer therapy
INFIXIMAB (remicade)
-effective treatment for IBD synchronized with steroids or sulfasalazine
75% of patients with chrons..
undergo surgery within 10 years
major issue associated with pharm treatment of IBD?
noncompliance :( uncle kenny i love uuuuu
greater chance of disease relapse
nutrition for IBD?
oral fluids, low residue, high protein, high calorie, supp vitamins, any foods that trigger diarrhea AVOID
-avoid smoking and cold food (increase intestinal motility)
MAY need TPN
what is toxic megacolon?
inflammation extends to muscularis, inabillity to contract, colonic distension (fever, pain, distension, vomiting, fatigue….) ifnot responding to treatment, surgery (total colectomy)
physiological responses can glucocorticoids?
at low doses, higher doses more intense
